EP1470790A1 - Ensemble d'instruments pour vis pédiculaire - Google Patents

Ensemble d'instruments pour vis pédiculaire Download PDF

Info

Publication number
EP1470790A1
EP1470790A1 EP03009326A EP03009326A EP1470790A1 EP 1470790 A1 EP1470790 A1 EP 1470790A1 EP 03009326 A EP03009326 A EP 03009326A EP 03009326 A EP03009326 A EP 03009326A EP 1470790 A1 EP1470790 A1 EP 1470790A1
Authority
EP
European Patent Office
Prior art keywords
screw
diameter
head
holder
centering
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP03009326A
Other languages
German (de)
English (en)
Other versions
EP1470790B1 (fr
Inventor
Simon Casutt
Nimrod Meier
Marc Huber
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Zimmer GmbH
Original Assignee
Zimmer GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Zimmer GmbH filed Critical Zimmer GmbH
Priority to EP03009326A priority Critical patent/EP1470790B1/fr
Priority to DE50302889T priority patent/DE50302889D1/de
Priority to DK03009326T priority patent/DK1470790T3/da
Priority to AT03009326T priority patent/ATE322219T1/de
Priority to ES03009326T priority patent/ES2258678T3/es
Priority to ZA200403008A priority patent/ZA200403008B/xx
Priority to JP2004125020A priority patent/JP2004344648A/ja
Priority to US10/829,123 priority patent/US7073415B2/en
Priority to AU2004201736A priority patent/AU2004201736B2/en
Priority to MXPA04003800A priority patent/MXPA04003800A/es
Priority to CNB2004100631448A priority patent/CN1286434C/zh
Priority to BR0401140-6A priority patent/BRPI0401140A/pt
Publication of EP1470790A1 publication Critical patent/EP1470790A1/fr
Application granted granted Critical
Publication of EP1470790B1 publication Critical patent/EP1470790B1/fr
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7008—Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7082—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7091—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8869—Tensioning devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length

Definitions

  • the present invention relates to an instrument system for pedicle screws with an internal thread in their head, which receives a grub screw with an outside diameter D 1 in the direction of its screw axis in order to clamp a connecting part which projects into the head transversely to the screw axis, a holder with projections engages positively on the head of the pedicle screw and a screwdriver with diameter D 4 can be attached to the grub screw.
  • Pedicle screws with clamping screws in their head are in the patent EP-A-0669 109.
  • DYNESYS® a stabilization system with pedicle screws and associated Instruments for vertebrae.
  • the object of the present invention is to improve this state and to give the surgeon more security.
  • This object is achieved according to the independent claim 1 in that at least two holders are provided with a tubular part and can be supported with the tubular part on the head of the pedicle screw, that a centering part can be used instead of the grub screw, which can also be screwed into the internal thread , can be gripped when the holder is in place and its outer diameter D corresponds to the diameter D 1 of the grub screw in order to pull off the same holder or other holder and to be able to bring it back to the form-fitting counter surfaces of the pedicle screw as often as desired, the tubular part having an inner diameter D 2 , which is only slightly larger than the diameter D 1 in order to attach the grub screw with the screwdriver or the centering part through the tubular part to the head of the pedicle screw, so that its thread engages with the internal thread without being edged.
  • This arrangement has the advantage that a grub screw can be used as a clamping screw outside the actual operating field in the tubular part and, under its own weight or pushed by the screwdriver, slides onto the head of the pedicle screw and can be screwed in there without the need for an instrument gripping the grub screw and without the risk of the grub screw being inadvertently placed at another location in the operating field.
  • the fact that the inside diameter D 2 of the tubular part is only slightly larger than the outside diameter D 1 of the grub screw keeps it in the position in which it was inserted into the tubular part.
  • the screwdriver finds its positive connection, for example, in a hexagon socket in the grub screw and the grub screw finds the thread in the head of the pedicle screw. The thread is reliably "found" when the inner diameter D 2 is less than 1.3 times the outer diameter D 1 of the grub screw.
  • a centering part anchored in this way allows the holder to be pulled off and the same or different holder to be put on again and without a direct view of the pedicle screw.
  • the pedicle screw can be placed without a grub screw by a first holder which has a corresponding tubular part, into which a centering part can be inserted instead of the grub screw, which can be gripped at its projecting end in order to screw it onto the head of the pedicle screw.
  • the largest diameter D of the centering part following a short threaded part is slightly larger than the thread diameter to form a support shoulder, but is still smaller than the inner diameter D 2 of the tubular part.
  • a centering part anchored in this way allows a first holder to be pulled off the head of the pedicle screw and other holders with other functions can be placed as often as desired without a direct view of the head of the pedicle screw.
  • a first holder can be designed as a powerful screw-in tool, which is positively supported on later functional surfaces of the head and, after screwing in the centering part, can be changed at a later time to another holder, which in turn is pushed on until it fits positively on auxiliary surfaces of the head to allow the grub screw to be inserted and fixed after the centering part has been removed.
  • This newly attached holder guides the grub screw and screwdriver and at the same time enables a counter-torque when the grub screw is tightened.
  • the dependent claims 2 to 12, 14 and 15 represent advantageous developments of the invention
  • the centering part thus enables holders with different functions to be changed, without losing contact with the head of the pedicle screw.
  • Such a centering part can be rigid.
  • a flexible elastic is even cheaper Version that, thanks to its flexibility, prevents the screwed centering part, when deflected large forces on the pedicle screw arise.
  • the centering parts can be bent so far that other devices, e.g. Imagers / X-ray devices can be used.
  • a holder guided on the centering part can also be attached to the head of an arch invisible pedicle screw and the covering tissue is gentle displace.
  • One way to create the necessary elasticity in the middle area consists in using a flexible material for the middle part and / or reduce the cross-section so that there are no impermissible bending stresses.
  • middle part is used as a multiple wire or as Coil spring to achieve a necessary elasticity.
  • this combination can be used as a setting tool for the pedicle screw be used.
  • the centering part is placed on the outside of the human body Pedicle screw on and secures the position of a retrofitted holder in axial direction by bracing it against the centering part, then screw in the pedicle screw with the holder. After releasing the clamp, the used as a setting tool because, for example, the form-fitting against it Surfaces of the pedicle screw are to be used for other purposes and another holder can be along the centering part to the head of the pedicle screw be introduced.
  • Such a different holder can for example be a holder with a be tubular part, which at the end to the pedicle screw as a deflection device projecting shoe with a deflection bow for a through the screw head as a connecting part has band drawn through it and at the other end of the tubular part - So outside of the actual field of operation with respect to rotation of the tubular Partially has a positive coupling surface for a belt tensioner, which the Band tensioner supports towards the pedicle screw.
  • This arrangement enables one Preloading outside the actual operating field and therefore comes with less Dimensions for the access routes.
  • Belt tensioner for such an application are suitable, are described in the patent EP-A-1103225.
  • a further pedicle screw is provided on a subsequent vertebra, it can as for the 2nd pedicle screw. Basically, you can also do it first all pedicle screws are placed with the first holder. It is all the more important that the centering parts remain screwed into the pedicle screws. It is for everyone other pedicle screws to be used, their position on the already protruding centering elements easier to estimate.
  • the holders in this instrument system have a tubular part, which is matched with its inner diameter to the alignment of the grub screw and protruding centering parts instead of the grub screws through the holder into the Heads of the pedicle screws can be fastened, the contact to the inserted pedicle screw even if it is not visible maintain a smaller operating field become.
  • Figures 1 and 2 is a fully assembled support member 30 between two adjacent Back vertebrae 31, 32 shown, which with an inventive instrument system is mountable.
  • the two pedicle screws 1 have a head 2 which is spherical and each has flattened end faces 33 on two opposite sides, which Form support surfaces for a cylindrical pressure pad 25. Transversely to the end faces 33 is in a bore, an elastic, pre-tensioned band 16 drawn through the pressure pad 25 and held in the screw head 2 by a grub screw 5.
  • the grub screw 5 lies on the screw axis 21 of the pedicle screw.
  • On the side surfaces of the Head 2 are notches 24 into which a holder 6b ( Figure 6) can move in order to Tightening the grub screws 5 with a screwdriver 10 a corresponding counter torque to build.
  • FIGS. 3, 4, 5 and 8 show the exemplary embodiment of a first holder 6a and its interaction on the head 2 of a pedicle screw 1 with a centering part 12 and with a clamping screw designed as a grub screw 5.
  • the holder 6a consists of a front part 26, which is designed as a tubular part 8 and ends in a mouth 27, which is supported on the head 2 of the pedicle screw 1 and engages around the free end faces 33 to a sufficiently large torque for screwing in the pedicle screw 1 to apply.
  • a centering part 12 is anchored in the internal thread 3 of the head 2 with a threaded part which corresponds to the external thread 9 of a clamping screw designed as a grub screw 5, but is considerably shorter in order to later pull in a band 16 even when the centering part 12 is screwed in and has a diameter D. can.
  • the grub screw 5 has a largest diameter D 1 and a hexagon socket 39 for the screwdriver 10.
  • the inner diameter D 2 of the tubular part 8 is only as large as that of a further holder 6 b (FIG. 6), which acts as a guide when inserting the clamping screw 5 is suitable.
  • the centering part 12 is therefore matched with its diameter D to the inside diameter D 2 of the tubular part 8 of both holders 6a, 6b, 6c, 6d, since it must be longitudinally displaceable in both holders in order to replace the holders with the centering part 12 screwed in can and on the other hand to be able to retract the centering part 12 with the first holder 6 a attached, and to screw it securely into the internal thread 3 on the head.
  • the front part 26 of the first holder 6 a is screwed tightly into a grip part 28, in which the tubular shape with a diameter D 2 continues.
  • a circumferential transverse groove 15 is provided in the region of the handle part 28, into which a lever 11 bifurcates in order to axially lock the screwed-in centering part 12 with a predetermined axial force.
  • the function that this locking element 14 performs could also be realized with a radially retracting set screw, the front edge of which is tapered. Without the transverse groove 15, clamping by a radially screwed-in screw would suffice.
  • the lever 11, which is fixed with an axle 29, is provided with a contour 38 against which a plunger 35, which is acted upon by a compression spring 36, presses.
  • the centering part 12 is locked.
  • the front part of the contour 38 which corresponds to a circular arc piece about the axis 29, reaches the plunger and in a region which is perpendicular to the plunger 35 from the axis 29, so that the centering part 12 and the first holder are released 6a can be detached from the head 2 and pulled off while the centering part 12 remains in the head.
  • a plug 37 closes the bore, which is necessary for the introduction of compression springs 36 and tappets 35.
  • This middle part 13 can, for example, deflect elastically up to 20 ° or more.
  • the conical transition pieces 20 prevent the middle part 13 from sticking to any edges despite deflection.
  • another holder 6 d is analogous to holder 6 a in the figures 3 and 4 with a centering part 12 shown. Since it is a first holder 6 d, which is used as a setting instrument, the centering part 12, which at later removal of the holder should remain, screwed to the pedicle screw are and then the holder 6 d are pushed on. In this case Centering part 12 can not be inserted through the holder.
  • the holder 6 d also has a tubular part 8 with mouth 27, has an elongated Handle part 28 with a clamping screw 73 protruding in the longitudinal axis, which is also associated with their outside graspable head 72 is supported on the grip part 28 and with a clamping thread 77 to protrudes into an internal thread 76 at the end of the centering part 12.
  • the centering part 12 has at the other end a thread 61 with an adjoining shoulder, with which it is Screwing the thread 61 is wedged against the head 2 of a pedicle screw while the clamping thread 77 rests on the internal thread 76 without wedging and is therefore located always loosens the first thread when the clamping screw 73 is turned back.
  • the tension screw 73 itself is blocked by the friction of its head 72 against the grip part 28. It it goes without saying that the thread 77 of the clamping screw 73 runs in the same direction as the thread 61 of the centering part 12 is executed.
  • the clamping screw 73 has two special features, which are very general for hand-operated Screws are applicable in technology. In order to overload the threads 77, 76 To prevent tensioning, the head 72 is kept so small and with an asymmetrical Profile provide that only small torques can be applied and that Because of the asymmetry, larger torques for loosening than for manual tensioning are applicable.
  • Figure 21 shows such an asymmetrical profile.
  • a clamping screw 73 with head 72 which is provided for a centering part 12 on a pedicle screw, that will Profile enclosed by an outer circle 80 with a diameter of 15 mm.
  • the profile repeats itself at a distance of 120 ° and is for a clamping screw 73 with a right-hand thread intended.
  • the edges are counterclockwise, over which the clamping torque has to be applied, much flatter than that clockwise for releasing the flanks. If you go from a maximum in the radial direction possible gripping force, then this is at a much lower torque reached clockwise.
  • outer circle 80 with a diameter of 15 mm are the clockwise flanks by a circular arc with a Radius 81 generated, which merges tangentially into the outer circle 80 and its center has an immennik with radius 79, which here is 1.5 mm.
  • the counterclockwise upcoming flanks are generated with a circular arc with a radius 83 that the Outer circle intersects vertically and has an amount of 2 mm, so that counterclockwise a shoulder 82 of about 2 mm protrudes.
  • tension screw 73 prevents it from unforeseen detaches from the grip part 28 and falls to the ground, for example, from the sterile area.
  • the clamping screw 73 On the shaft the clamping screw 73 has a protruding thread 74 attached by a counter thread 75 must be screwed in the handle 28. Before the clamping screw 73 deeper can be pushed into the handle. Few threads prevent the tightening screw on its transport from the sterilization to the operating room or detaches from the handle part when the holder is used several times.
  • Figures 22 and 18 show a measure that allows an annular support surface 70 in the axial direction on the head 2 of a pedicle screw tubular part 8, if a corresponding counter surface at the mouth 27 the holder 6 a and 6 d is present.
  • Side centering that is for that Collapse of the longitudinal axes of the pedicle screw 1 and the tubular Part 8 provide the jaws of the mouth 27 projecting above the support surfaces 70 Pedicle screw can therefore not like a despite the spherical partial surfaces on the head 2 Joint in the mouth 27 are moved.
  • Such an arrangement is not only for hand-operated Setting devices according to the holders 6 a and 6 d advantageous, but can also for setting tools of navigation systems (CAS, computer assisted surgery) be used when using the location of the tip of a pedicle screw to a holder recordable reference position should be adhered to exactly, always on the condition that this holder has a centering part 12, which are in the head of the pedicle screw remains when the holder is loosened from the screwed pedicle screw and pulled off.
  • a centering part would then, in the sense of the invention, the subsequent manual ones Favor surgical steps with suitable additional holders.
  • FIGS. 6, 7, 8 and 9 describe the function of a second holder 6 b which, after the first holder 6 a or 6 d has been extended, can be pushed onto the head 2 of the first pedicle screw 1 and is oriented on the centering part 12 , Protrusions 7 are positively inserted into notches 24 on the head 2 of the pedicle screws.
  • a mouthpiece 27 is made in this holder as a separate part from a high-quality, wear-resistant steel and then connected to the tubular part 8, which leads through a transverse handle 40 in order to generate a counter torque when tightening the grub screw 5.
  • the inner diameter D 2 of the tubular part 8 is smaller than 1.3 times or even better smaller than 1.1 times the outer diameter D 1 of the grub screw 5, around which, after the centering part 12 has been removed, it is guided up to the internal thread 3 poking in the head.
  • the screwdriver 10 in FIG. 9 has a hexagon which fits into the hexagon socket 39 of the grub screw 5.
  • the outside diameter D 4 of the screwdriver 10 is selected such that it is guided in the tubular part 8 with the inside diameter D 2 and finds the hexagon socket 39 of the grub screw 5.
  • the front part of the screwdriver 10 with the diameter D 4 is so long that it can be used with holders 6b and 6c to tighten grub screws 5 inserted with its handle 40.
  • FIGS. 11, 12 and 13 show a further holder 6c which is on the second Pedicle screw can be pushed over a centering element 12.
  • the second came before Pedicle screw with the first holder 6 a or 6 d set, this was then deducted and a centering element 12 remained.
  • the in Fig 10 shown spreading tool 42 the distance between the first and second pedicle screw determined under a certain distraction force and a suitable pressure pad 25 on the tape 16 pulled up and the tape with the centering part 12 still attached pulled the head 2 of the second pedicle screw.
  • the further holder 6 c also has a separately manufactured mouth 27 to which one Shoe 17 is formed, which through a through hole when the holder is attached Head 2 continues with a deflection bend 18 by approximately 90 °, the deflection bend 18 infinitely attaches with its base 19 to the through hole.
  • the bend is with a radius of curvature of more than 3 mm, so that even with a stiff the through-drawn band 16 does not cause too much friction due to the deflection arises.
  • the deflection bend 18 is movable Deflection bend, that is, has been replaced by a roller 18a, which in the shoe 17 in laterally projecting jaws is stored.
  • the upper part of the holder 6 c is designed as a cantilever arm 43, which coupling surfaces 23 for a pincer-shaped band tensioner (not shown).
  • a pincer-shaped band tensioner (not shown).
  • Such tape tensioner are separate, plier-like tools with two widening one another Legs, one of which is supported, for example, on the head 2 of the pedicle screw, while the other grips the tape and pulls past the first leg.
  • belt tensioner are used as tools for the previously mentioned product DYNESYS ® from Centerpulse Orthopedics Ltd sold.
  • Such a belt tensioner is with the non-gripping leg attached to the coupling surface 23 after the band 16 through the gripping Thigh was packed.
  • the coupling surface 23 secures the non-gripping leg against rotation around the tubular part 8 and at the same time supports it in the direction of the Deflection bend 18.
  • An operator can therefore operate the belt tensioner with one hand and a counter moment on the holder 6c and its projections 7 on the head 2 of the pedicle screw generate while operating the screwdriver 10 with the other hand can to fix the band when a predetermined tension in the band 16 reaches is.
  • a slot 44 is made in the coupling surface 23 towards the deflection bend through which the band 16 is inserted laterally when the band tensioner is attached. It is advantageous if the slot 44 merges into a larger bore via a bottleneck 69 and the bottleneck 69 is dimensioned such that a band is forced into the side Hole must be pushed so that it is caught in the hole and out of the Operation field is brought out without accidentally falling back into the operation field can.
  • FIG. 10 shows a spreading instrument 42 in which two levers 47, 48 are like one Cross the pliers in a fulcrum 53.
  • a screw 57 Crossbar 49 attached, which crosses the other lever 48 in an arc and in a handle 50 ends.
  • the first lever continues outwards in two parts, in a rigid pointer part 52 and in an attached spiral spring 51 with a thumb grip 56 protrudes over the arch of the crossbar 49.
  • the tip of the first lever 47 is fork-shaped. This fork 46 lies on the head of the first Pedicle screw and centered on the emerging band 16.
  • the tip of the other Lever 48 ends in a laterally protruding hemisphere 45, which is located on the through hole centered on the second pedicle screw. If now by tightening the thumb a spreading force is applied, the spiral spring 51 deforms to the handle 50 there, while the rigid pointer part 52 only moves on the arch of the crossbar 49 by as much, how the tips of the levers 47, 48 move apart.
  • a first scale 54 is attached, on the outer distance between the tips of the levers 47, 48 can be read.
  • a further, second scale 55 is connected to the thumb grip 56 and records the movement the spiral spring 51 joins in and indicates relative to the pointer part 52 under what pretensioning force the two tips are pressed apart.
  • the purpose of the instrument is there in that it can be operated with one hand, and that for a given between the vertebrae Preload is determined the length, which is a reference size for a later to be used Pressure pad 25 forms. According to the elastic properties of the material for the pressure pad 25, this must be in the unstressed state with regard to the reference size be cut so that it is after installing and tensioning the tape takes an intended length.
  • a further application of the invention can be transferred according to patent claims 13 to 15 and FIGS. 14, 15, 16, 17 to further versions of instruments which provide a screw 5 'with a protruding screw head 58, for example a hexagon, as a clamping screw.
  • the outer diameter D 4 'of a rotary screwdriver 10 is decisive for the inner diameter D 2 ' of a tubular part 8, which has a gripping device 59 for a screw head 58 on its suitable hexagon socket 67, aligned around the hexagon screw 5 ' to keep on the axis 62 of the screwdriver 10.
  • the inside diameter D 2 ' only slightly, for example by less than 1.2 times the larger tubular part 8 then leads indirectly via the screwdriver 10 the clamping screw with its thread 60 to the internal thread 3 in the head 2 of the pedicle screw 1 approach.
  • the holder 66 is supported with its mouth 27 on the head 2 of the pedicle screw and engages with projections 7 in a form-fitting manner in notches in order to form a counter-torque when the hexagon screw 5 'is screwed in, which fixes the retracted band 16.
  • the screwdriver 10 comprises the screw head 58, the screw 5 ′ being pressed into the internal hexagon 67 using a spring 64, which extends opposite over the lower edge of the screw head 58.
  • the spring is C-shaped and pushed from behind through a keyway 65 in the shaft of the screwdriver 10 and secured by a subsequently inserted key 63.
  • the legs of the spring 64 form a projection at their end, which springs back when the screw head 58 is inserted and holds it on its lower edge.
  • the legs themselves are each embedded in a groove so that they do not protrude beyond the diameter D 4 of the screwdriver.
  • FIG. 14 shows a holder 68 matching FIG. 15 with a centering part 12, the diameter D 'of which is slightly smaller than the diameter D 2 ' of the holders 66, 68 so that they can find their form-fitting counter surfaces on the head 2 of the pedicle screw 1.
  • the centering part 12 is anchored with a thread 61 in the internal thread 3 on the head 2 of a pedicle screw 1. It has conical transitions 20 to a central part 13, which is flexible with a smaller diameter D 3 .
  • the holder 68 is adapted with its mouth 27 to the flattened end faces 33 of the head 2.
  • FIGS. 14 and 15 there is a further holder which has a tubular part like the holder in FIG. 15 and also the shoe 17 and a deflection device 22 like the holder 6 c (FIG. 8) and an arm 43 for has a belt tensioner.
  • the centering parts 12 From the instrument set according to FIGS. 15 to 17 it can generally be said that the centering parts 12 have a largest diameter D 'which is smaller than the diameter D 2 ' of the tubular part 8.
  • Other dimensions such as wall thicknesses of the tubular part 8 and further details and length dimensions of the instruments can correspond to the instrument set of FIGS. 3 to 9, 11 to 13 and FIG. 21.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Neurology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Non-Disconnectible Joints And Screw-Threaded Joints (AREA)
  • Screw Conveyors (AREA)
  • Details Of Spanners, Wrenches, And Screw Drivers And Accessories (AREA)
  • Earth Drilling (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)
EP03009326A 2003-04-24 2003-04-24 Ensemble d'instruments pour vis pédiculaire Expired - Lifetime EP1470790B1 (fr)

Priority Applications (12)

Application Number Priority Date Filing Date Title
EP03009326A EP1470790B1 (fr) 2003-04-24 2003-04-24 Ensemble d'instruments pour vis pédiculaire
DE50302889T DE50302889D1 (de) 2003-04-24 2003-04-24 Instrumentensystem für Pedikelschrauben
DK03009326T DK1470790T3 (da) 2003-04-24 2003-04-24 Instrumentsystem til pedikelskruer
AT03009326T ATE322219T1 (de) 2003-04-24 2003-04-24 Instrumentensystem für pedikelschrauben
ES03009326T ES2258678T3 (es) 2003-04-24 2003-04-24 Sistema instrumental para tornillos pediculares.
ZA200403008A ZA200403008B (en) 2003-04-24 2004-04-20 An instrument system for pedicle screws.
JP2004125020A JP2004344648A (ja) 2003-04-24 2004-04-21 ペディクルスクリュー用計器システム
US10/829,123 US7073415B2 (en) 2003-04-24 2004-04-21 Instrument system for pedicle screws
AU2004201736A AU2004201736B2 (en) 2003-04-24 2004-04-22 An instrument system for pedicle screws
MXPA04003800A MXPA04003800A (es) 2003-04-24 2004-04-22 Un sistema de instrumentos para tornillos de pediculo.
CNB2004100631448A CN1286434C (zh) 2003-04-24 2004-04-23 用于椎弓根螺钉的器械系统
BR0401140-6A BRPI0401140A (pt) 2003-04-24 2004-04-26 Sistema de instrumento para parafusos de pedìculo

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
EP03009326A EP1470790B1 (fr) 2003-04-24 2003-04-24 Ensemble d'instruments pour vis pédiculaire

Publications (2)

Publication Number Publication Date
EP1470790A1 true EP1470790A1 (fr) 2004-10-27
EP1470790B1 EP1470790B1 (fr) 2006-04-05

Family

ID=32946875

Family Applications (1)

Application Number Title Priority Date Filing Date
EP03009326A Expired - Lifetime EP1470790B1 (fr) 2003-04-24 2003-04-24 Ensemble d'instruments pour vis pédiculaire

Country Status (12)

Country Link
US (1) US7073415B2 (fr)
EP (1) EP1470790B1 (fr)
JP (1) JP2004344648A (fr)
CN (1) CN1286434C (fr)
AT (1) ATE322219T1 (fr)
AU (1) AU2004201736B2 (fr)
BR (1) BRPI0401140A (fr)
DE (1) DE50302889D1 (fr)
DK (1) DK1470790T3 (fr)
ES (1) ES2258678T3 (fr)
MX (1) MXPA04003800A (fr)
ZA (1) ZA200403008B (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8439922B1 (en) 2008-02-06 2013-05-14 NiVasive, Inc. Systems and methods for holding and implanting bone anchors
US9737339B2 (en) 2004-09-08 2017-08-22 Nuvasive, Inc. Posterio spinal fixation
US10426527B2 (en) 2011-02-10 2019-10-01 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods

Families Citing this family (138)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6875212B2 (en) * 2000-06-23 2005-04-05 Vertelink Corporation Curable media for implantable medical device
WO2002000126A1 (fr) * 2000-06-23 2002-01-03 University Of Southern California Systeme de fusion vertebrale percutanee
US6899713B2 (en) 2000-06-23 2005-05-31 Vertelink Corporation Formable orthopedic fixation system
US6964667B2 (en) * 2000-06-23 2005-11-15 Sdgi Holdings, Inc. Formed in place fixation system with thermal acceleration
FR2812185B1 (fr) * 2000-07-25 2003-02-28 Spine Next Sa Piece de liaison semi-rigide pour la stabilisation du rachis
US7833250B2 (en) 2004-11-10 2010-11-16 Jackson Roger P Polyaxial bone screw with helically wound capture connection
US20160242816A9 (en) 2001-05-09 2016-08-25 Roger P. Jackson Dynamic spinal stabilization assembly with elastic bumpers and locking limited travel closure mechanisms
US10729469B2 (en) 2006-01-09 2020-08-04 Roger P. Jackson Flexible spinal stabilization assembly with spacer having off-axis core member
US10258382B2 (en) 2007-01-18 2019-04-16 Roger P. Jackson Rod-cord dynamic connection assemblies with slidable bone anchor attachment members along the cord
US7862587B2 (en) 2004-02-27 2011-01-04 Jackson Roger P Dynamic stabilization assemblies, tool set and method
KR100849292B1 (ko) * 2003-03-31 2008-07-29 샤프 가부시키가이샤 액정 표시 장치 및 그 제조 방법
US7473267B2 (en) * 2003-04-25 2009-01-06 Warsaw Orthopedic, Inc. System and method for minimally invasive posterior fixation
US7776067B2 (en) 2005-05-27 2010-08-17 Jackson Roger P Polyaxial bone screw with shank articulation pressure insert and method
US7468064B2 (en) * 2003-08-21 2008-12-23 Warsaw Orthopedic, Inc. Systems and methods for positioning implants relative to bone anchors in surgical approaches to the spine
US7955355B2 (en) 2003-09-24 2011-06-07 Stryker Spine Methods and devices for improving percutaneous access in minimally invasive surgeries
US8002798B2 (en) 2003-09-24 2011-08-23 Stryker Spine System and method for spinal implant placement
US8105367B2 (en) 2003-09-29 2012-01-31 Smith & Nephew, Inc. Bone plate and bone plate assemblies including polyaxial fasteners
US7967826B2 (en) * 2003-10-21 2011-06-28 Theken Spine, Llc Connector transfer tool for internal structure stabilization systems
US7588575B2 (en) * 2003-10-21 2009-09-15 Innovative Spinal Technologies Extension for use with stabilization systems for internal structures
US11241261B2 (en) 2005-09-30 2022-02-08 Roger P Jackson Apparatus and method for soft spinal stabilization using a tensionable cord and releasable end structure
WO2005097411A2 (fr) * 2004-03-30 2005-10-20 Kinamed, Inc. Tournevis chirurgical electrique
US7766941B2 (en) * 2004-05-14 2010-08-03 Paul Kamaljit S Spinal support, stabilization
FR2870718B1 (fr) * 2004-05-25 2006-09-22 Spine Next Sa Ensemble de traitement de la degenerescence d'un disque intervertebral
US8034085B2 (en) * 2004-05-28 2011-10-11 Depuy Spine, Inc. Non-fusion spinal correction systems and methods
US7666189B2 (en) * 2004-09-29 2010-02-23 Synthes Usa, Llc Less invasive surgical system and methods
US9168069B2 (en) 2009-06-15 2015-10-27 Roger P. Jackson Polyaxial bone anchor with pop-on shank and winged insert with lower skirt for engaging a friction fit retainer
US9393047B2 (en) 2009-06-15 2016-07-19 Roger P. Jackson Polyaxial bone anchor with pop-on shank and friction fit retainer with low profile edge lock
EP1719468A1 (fr) * 2004-12-17 2006-11-08 Zimmer GmbH Système de stabilisation intervertébrale du rachis
US7901437B2 (en) 2007-01-26 2011-03-08 Jackson Roger P Dynamic stabilization member with molded connection
US8177817B2 (en) * 2005-05-18 2012-05-15 Stryker Spine System and method for orthopedic implant configuration
US7628800B2 (en) * 2005-06-03 2009-12-08 Warsaw Orthopedic, Inc. Formed in place corpectomy device
US7828825B2 (en) * 2005-06-20 2010-11-09 Warsaw Orthopedic, Inc. Multi-level multi-functional spinal stabilization systems and methods
US8382807B2 (en) 2005-07-25 2013-02-26 Smith & Nephew, Inc. Systems and methods for using polyaxial plates
CN101272743B (zh) 2005-07-25 2011-01-26 史密夫和内修有限公司 使用多轴式板的系统
WO2007038429A1 (fr) 2005-09-27 2007-04-05 Endius, Inc. Procédés et appareils de stabilisation de la colonne vertébrale par le biais d’un dispositif d’accès
US8100946B2 (en) 2005-11-21 2012-01-24 Synthes Usa, Llc Polyaxial bone anchors with increased angulation
WO2007114864A2 (fr) * 2005-12-07 2007-10-11 Blackstone Medical, Inc. Dispositif et procéde pour tenir et insérer un ou plusieurs composants d'un ensemble vis de pédicule
US8894655B2 (en) 2006-02-06 2014-11-25 Stryker Spine Rod contouring apparatus and method for percutaneous pedicle screw extension
AU2007238129A1 (en) 2006-04-11 2007-10-25 Synthes Gmbh Minimally invasive fixation system
US20070270838A1 (en) * 2006-05-08 2007-11-22 Sdgi Holdings, Inc. Dynamic spinal stabilization device with dampener
US7785350B2 (en) * 2006-05-08 2010-08-31 Warsaw Orthopedic, Inc. Load bearing flexible spinal connecting element
US8012179B2 (en) * 2006-05-08 2011-09-06 Warsaw Orthopedic, Inc. Dynamic spinal stabilization members and methods
US7927356B2 (en) * 2006-07-07 2011-04-19 Warsaw Orthopedic, Inc. Dynamic constructs for spinal stabilization
US9526525B2 (en) * 2006-08-22 2016-12-27 Neuropro Technologies, Inc. Percutaneous system for dynamic spinal stabilization
DE602007014385D1 (de) 2006-09-25 2011-06-16 Stryker Spine Perkutanes kompressions- und distraktionssystem
US7686809B2 (en) 2006-09-25 2010-03-30 Stryker Spine Rod inserter and rod with reduced diameter end
US8038699B2 (en) 2006-09-26 2011-10-18 Ebi, Llc Percutaneous instrument assembly
US8162952B2 (en) 2006-09-26 2012-04-24 Ebi, Llc Percutaneous instrument assembly
US7947045B2 (en) * 2006-10-06 2011-05-24 Zimmer Spine, Inc. Spinal stabilization system with flexible guides
US20080114457A1 (en) * 2006-11-14 2008-05-15 Warsaw Orthopedic, Inc. Methods and devices for connecting implants and devices
US20080119862A1 (en) * 2006-11-21 2008-05-22 Wicker Meleah Ann Surgical Instrument for Supplying a Counter-Torque When Securing a Spinal Prosthesis
WO2008070716A2 (fr) * 2006-12-05 2008-06-12 Spine Wave, Inc. Dispositifs et procédés de stabilisation dynamique
US8758407B2 (en) * 2006-12-21 2014-06-24 Warsaw Orthopedic, Inc. Methods for positioning a load-bearing orthopedic implant device in vivo
US8663328B2 (en) * 2006-12-21 2014-03-04 Warsaw Orthopedic, Inc. Methods for positioning a load-bearing component of an orthopedic implant device by inserting a malleable device that hardens in vivo
US8480718B2 (en) * 2006-12-21 2013-07-09 Warsaw Orthopedic, Inc. Curable orthopedic implant devices configured to be hardened after placement in vivo
US7771476B2 (en) 2006-12-21 2010-08-10 Warsaw Orthopedic Inc. Curable orthopedic implant devices configured to harden after placement in vivo by application of a cure-initiating energy before insertion
US8747445B2 (en) 2007-01-15 2014-06-10 Ebi, Llc Spinal fixation device
US11224463B2 (en) 2007-01-18 2022-01-18 Roger P. Jackson Dynamic stabilization connecting member with pre-tensioned flexible core member
US8366745B2 (en) 2007-05-01 2013-02-05 Jackson Roger P Dynamic stabilization assembly having pre-compressed spacers with differential displacements
US8475498B2 (en) 2007-01-18 2013-07-02 Roger P. Jackson Dynamic stabilization connecting member with cord connection
US8052727B2 (en) * 2007-03-23 2011-11-08 Zimmer Gmbh System and method for insertion of flexible spinal stabilization element
WO2008131084A2 (fr) * 2007-04-17 2008-10-30 K2M, Inc. Dispositif de rétraction intercorporel à accès ouvert minimal et procédé chirurgical
US7922725B2 (en) * 2007-04-19 2011-04-12 Zimmer Spine, Inc. Method and associated instrumentation for installation of spinal dynamic stabilization system
US10383660B2 (en) 2007-05-01 2019-08-20 Roger P. Jackson Soft stabilization assemblies with pretensioned cords
US20080275504A1 (en) * 2007-05-02 2008-11-06 Bonin Henry K Constructs for dynamic spinal stabilization
US20080312694A1 (en) * 2007-06-15 2008-12-18 Peterman Marc M Dynamic stabilization rod for spinal implants and methods for manufacturing the same
US9439681B2 (en) 2007-07-20 2016-09-13 DePuy Synthes Products, Inc. Polyaxial bone fixation element
DE602007007758D1 (de) 2007-07-31 2010-08-26 Biedermann Motech Gmbh Knochenverankerungsvorrichtung
WO2009021115A2 (fr) * 2007-08-07 2009-02-12 Alpinespine Llc Manche de tournevis équipé d'un système de blocage
US8156847B2 (en) * 2007-08-07 2012-04-17 Alphatec Spine, Inc. Undercut screw feature and driver
US9039711B2 (en) * 2007-08-21 2015-05-26 DePuy Synthes Products, Inc. Instruments and methods for tensioning a spinal tether
US8323294B2 (en) * 2007-08-21 2012-12-04 Depuy Spine, Inc. Tether tensioning instrument
US20090093843A1 (en) * 2007-10-05 2009-04-09 Lemoine Jeremy J Dynamic spine stabilization system
US9277940B2 (en) 2008-02-05 2016-03-08 Zimmer Spine, Inc. System and method for insertion of flexible spinal stabilization element
USD620109S1 (en) 2008-02-05 2010-07-20 Zimmer Spine, Inc. Surgical installation tool
US8292899B2 (en) * 2008-05-15 2012-10-23 Olsen Russell G Apparatus and system for orthopedic fastener insertion and extraction
AU2010260521C1 (en) 2008-08-01 2013-08-01 Roger P. Jackson Longitudinal connecting member with sleeved tensioned cords
JP5687197B2 (ja) * 2008-09-03 2015-03-18 シンピライカ スパイン， インコーポレイテッド 人工装具を脊髄分節に結合するための方法および装置
WO2010030906A1 (fr) 2008-09-12 2010-03-18 Synthes Usa, Llc Système de fixation de stabilisation et de guidage de colonne vertébrale
KR20110081208A (ko) 2008-09-29 2011-07-13 신세스 게엠바하 다축 저부-적재 나사 및 로드 조립체
US8388659B1 (en) 2008-10-17 2013-03-05 Theken Spine, Llc Spondylolisthesis screw and instrument for implantation
CN102202589A (zh) 2008-11-03 2011-09-28 斯恩蒂斯有限公司 单平面的骨固定组件
US20100114165A1 (en) * 2008-11-04 2010-05-06 Abbott Spine, Inc. Posterior dynamic stabilization system with pivoting collars
US8075565B2 (en) * 2008-11-05 2011-12-13 Warsaw Orthopedic, Inc. Surgical instruments for delivering forces to bony structures
US20100137908A1 (en) * 2008-12-01 2010-06-03 Zimmer Spine, Inc. Dynamic Stabilization System Components Including Readily Visualized Polymeric Compositions
US9055979B2 (en) * 2008-12-03 2015-06-16 Zimmer Gmbh Cord for vertebral fixation having multiple stiffness phases
US8137356B2 (en) * 2008-12-29 2012-03-20 Zimmer Spine, Inc. Flexible guide for insertion of a vertebral stabilization system
CA2758590A1 (fr) 2009-04-15 2010-10-21 Synthes Usa, Llc Connecteur de revision pour constructions rachidiennes
CA2762606A1 (fr) 2009-05-20 2010-11-25 Synthes Usa, Llc Retraction montee sur un patient
US9668771B2 (en) 2009-06-15 2017-06-06 Roger P Jackson Soft stabilization assemblies with off-set connector
US11229457B2 (en) 2009-06-15 2022-01-25 Roger P. Jackson Pivotal bone anchor assembly with insert tool deployment
US9510862B2 (en) 2009-06-17 2016-12-06 DePuy Synthes Products, Inc. Revision connector for spinal constructs
US8876867B2 (en) 2009-06-24 2014-11-04 Zimmer Spine, Inc. Spinal correction tensioning system
US8267968B2 (en) * 2009-06-24 2012-09-18 Neuropro Technologies, Inc. Percutaneous system for dynamic spinal stabilization
US20110009906A1 (en) * 2009-07-13 2011-01-13 Zimmer Spine, Inc. Vertebral stabilization transition connector
US9655658B2 (en) 2009-10-14 2017-05-23 Ebi, Llc Deformable device for minimally invasive fixation
GB2488284B (en) 2009-11-10 2015-12-09 Nuvasive Inc Apparatus for performing spinal fusion surgery
US8328849B2 (en) * 2009-12-01 2012-12-11 Zimmer Gmbh Cord for vertebral stabilization system
US9431868B2 (en) * 2010-01-19 2016-08-30 Tolomatic, Inc. Manual override device for an electric actuator and method for use
US8740945B2 (en) 2010-04-07 2014-06-03 Zimmer Spine, Inc. Dynamic stabilization system using polyaxial screws
US8535318B2 (en) 2010-04-23 2013-09-17 DePuy Synthes Products, LLC Minimally invasive instrument set, devices and related methods
US8540756B2 (en) 2010-05-03 2013-09-24 Ortho Vation Medical Llc Surgical fastener and associated systems and methods
EP2384709B1 (fr) 2010-05-05 2012-09-05 Biedermann Technologies GmbH & Co. KG Pièce de réception destinée à recevoir une tige pour coupler la tige à un élément d'ancrage d'os, dispositif d'ancrage d'os, procédé et outil d'assemblage
WO2011153455A2 (fr) * 2010-06-04 2011-12-08 The University Of North Carolina At Chapel Hill Appareils, systèmes et procédés de retenue d'une vis sur un tournevis
US8382803B2 (en) 2010-08-30 2013-02-26 Zimmer Gmbh Vertebral stabilization transition connector
EP2613719A1 (fr) 2010-09-08 2013-07-17 Roger P. Jackson Membres de stabilisation dynamiques dotés de sections élastiques et non élastiques
US9907582B1 (en) 2011-04-25 2018-03-06 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods
US9307972B2 (en) 2011-05-10 2016-04-12 Nuvasive, Inc. Method and apparatus for performing spinal fusion surgery
AU2012262698B2 (en) 2011-05-27 2016-07-21 Synthes Gmbh Minimally invasive spinal fixation system including vertebral alignment features
US8491588B2 (en) 2011-06-13 2013-07-23 Warsaw Orthopedic, Inc. Surgical instrument for securing a spinal rod
CN103717179B (zh) 2011-06-15 2017-08-08 史密夫和内修有限公司 可变角度锁定植入物
US9125703B2 (en) 2012-01-16 2015-09-08 K2M, Inc. Rod reducer, compressor, distractor system
US9427260B2 (en) * 2012-03-01 2016-08-30 Globus Medical, Inc. Closed-head polyaxial and monaxial screws
FR2993449B1 (fr) * 2012-07-19 2014-07-11 Safe Orthopaedics Dispositif de guidage d'un instrument chirurgical en position sur un element d'ancrage osseux comprenant des moyens de realignement d'une tige de liaison avec l'element d'ancrage
FR2997007B1 (fr) * 2012-10-19 2015-10-30 Teknimed Systeme de fixation d'un materiel d'osteosynthese
CA2846149C (fr) 2013-03-14 2018-03-20 Stryker Spine Systemes et procedes de fusion spinale percutanee
US9827020B2 (en) 2013-03-14 2017-11-28 Stryker European Holdings I, Llc Percutaneous spinal cross link system and method
US9486256B1 (en) 2013-03-15 2016-11-08 Nuvasive, Inc. Rod reduction assemblies and related methods
ES2745673T3 (es) * 2013-03-15 2020-03-03 Shriners Hospitals Children Técnicas para la cirugía de columna vertebral
US10159579B1 (en) 2013-12-06 2018-12-25 Stryker European Holdings I, Llc Tubular instruments for percutaneous posterior spinal fusion systems and methods
US9744050B1 (en) 2013-12-06 2017-08-29 Stryker European Holdings I, Llc Compression and distraction system for percutaneous posterior spinal fusion
US9408716B1 (en) 2013-12-06 2016-08-09 Stryker European Holdings I, Llc Percutaneous posterior spinal fusion implant construction and method
AU2014274626B2 (en) 2013-12-13 2019-12-12 Stryker European Operations Holdings Llc Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion
US9597119B2 (en) 2014-06-04 2017-03-21 Roger P. Jackson Polyaxial bone anchor with polymer sleeve
US10064658B2 (en) 2014-06-04 2018-09-04 Roger P. Jackson Polyaxial bone anchor with insert guides
WO2016094588A2 (fr) 2014-12-09 2016-06-16 Heflin John A Système d'alignement de colonne vertébrale
US9987066B2 (en) 2014-12-15 2018-06-05 Medos International Sarl Bone anchor driver and methods
US9974577B1 (en) 2015-05-21 2018-05-22 Nuvasive, Inc. Methods and instruments for performing leveraged reduction during single position spine surgery
WO2017048909A1 (fr) 2015-09-18 2017-03-23 Smith & Nephew, Inc. Plaque osseuse
US10194960B1 (en) 2015-12-03 2019-02-05 Nuvasive, Inc. Spinal compression instrument and related methods
US10398481B2 (en) 2016-10-03 2019-09-03 Nuvasive, Inc. Spinal fixation system
WO2018167381A1 (fr) * 2017-03-15 2018-09-20 Onecox Broche de guidage intra-osseux, trocart de pose et trocart de retrait de ladite broche
US10939941B2 (en) 2017-08-29 2021-03-09 Zimmer Biomet Spine, Inc. Surgical cord tensioning devices, systems, and methods
ES2900054T3 (es) 2017-08-29 2022-03-15 Zimmer Biomet Spine Inc Sistemas tensores de cordón quirúrgico
US11020149B2 (en) * 2018-02-28 2021-06-01 Globus Medical Inc. Scoliosis correction systems, methods, and instruments
US11051861B2 (en) 2018-06-13 2021-07-06 Nuvasive, Inc. Rod reduction assemblies and related methods
US11534222B2 (en) * 2020-10-07 2022-12-27 Globus Medical, Inc. Tensioning instruments
CN114376704A (zh) * 2021-12-30 2022-04-22 衢州市人民医院 一种颈椎3d打印导航模板及其制备方法

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2703288A1 (fr) * 1993-03-31 1994-10-07 Bellemere Philippe Porte-outil universel notamment pour la mise en place d'organes de fixation dans des supports difficilement accessibles.
US6235028B1 (en) * 2000-02-14 2001-05-22 Sdgi Holdings, Inc. Surgical guide rod
US6251112B1 (en) * 2000-04-18 2001-06-26 Roger P. Jackson Thin profile closure cap for open ended medical implant
DE10005134A1 (de) * 2000-02-04 2001-08-16 Copf Jun Vergurtungssystem zur Spondylodese der Lendenwirbelsäule sowie Pedikelschraube und Gegenhalter zur Verwendung bei einem solchen

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5520702A (en) 1994-02-24 1996-05-28 United States Surgical Corporation Method and apparatus for applying a cinch member to the ends of a suture
DE59408313D1 (de) 1994-02-28 1999-07-01 Sulzer Orthopaedie Ag Stabilisierung von benachbarten Rückenwirbeln
US5941885A (en) * 1996-10-08 1999-08-24 Jackson; Roger P. Tools for use in installing osteosynthesis apparatus utilizing set screw with break-off head
EP1103225B1 (fr) 1999-11-25 2004-09-15 Centerpulse Orthopedics Ltd. Instrument chirurgical de mise en tension d'un élément de tension en forme de câble

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2703288A1 (fr) * 1993-03-31 1994-10-07 Bellemere Philippe Porte-outil universel notamment pour la mise en place d'organes de fixation dans des supports difficilement accessibles.
DE10005134A1 (de) * 2000-02-04 2001-08-16 Copf Jun Vergurtungssystem zur Spondylodese der Lendenwirbelsäule sowie Pedikelschraube und Gegenhalter zur Verwendung bei einem solchen
US6235028B1 (en) * 2000-02-14 2001-05-22 Sdgi Holdings, Inc. Surgical guide rod
US6251112B1 (en) * 2000-04-18 2001-06-26 Roger P. Jackson Thin profile closure cap for open ended medical implant

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9737339B2 (en) 2004-09-08 2017-08-22 Nuvasive, Inc. Posterio spinal fixation
US8439922B1 (en) 2008-02-06 2013-05-14 NiVasive, Inc. Systems and methods for holding and implanting bone anchors
US9192415B1 (en) 2008-02-06 2015-11-24 Nuvasive, Inc. Systems and methods for holding and implanting bone anchors
US9492208B1 (en) 2008-02-06 2016-11-15 Nuvasive, Inc. Systems and methods for holding and implanting bone anchors
US9757166B1 (en) 2008-02-06 2017-09-12 Nuvasive, Inc. Systems and methods for holding and implanting bone anchors
US10004544B2 (en) 2008-02-06 2018-06-26 Nuvasive, Inc. Systems and methods for introducing a bone anchor
US10426526B2 (en) 2008-02-06 2019-10-01 Nuvasive, Inc. Systems and methods for introducing a bone anchor
US11311320B2 (en) 2008-02-06 2022-04-26 Nuvasive, Inc. Systems and methods for introducing a bone anchor
US10426527B2 (en) 2011-02-10 2019-10-01 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods
US11406429B2 (en) 2011-02-10 2022-08-09 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods
US11723698B2 (en) 2011-02-10 2023-08-15 Nuvasive, Inc. Minimally invasive spinal fixation system and related methods

Also Published As

Publication number Publication date
EP1470790B1 (fr) 2006-04-05
AU2004201736B2 (en) 2008-01-10
ZA200403008B (en) 2006-02-22
DE50302889D1 (de) 2006-05-18
AU2004201736A1 (en) 2004-11-11
JP2004344648A (ja) 2004-12-09
CN1286434C (zh) 2006-11-29
DK1470790T3 (da) 2006-08-07
US7073415B2 (en) 2006-07-11
CN1550219A (zh) 2004-12-01
ATE322219T1 (de) 2006-04-15
MXPA04003800A (es) 2005-06-03
US20050010220A1 (en) 2005-01-13
ES2258678T3 (es) 2006-09-01
BRPI0401140A (pt) 2005-02-09

Similar Documents

Publication Publication Date Title
EP1470790B1 (fr) Ensemble d'instruments pour vis pédiculaire
EP2266483B1 (fr) Dispositif d'ancrage osseux chirurgical et système de fixation de la colonne vertébrale
EP2692304B1 (fr) Instrumentation chirurgicale
EP0650344B1 (fr) Element de fixation pour osteosynthese et accessoire de manipulation
EP2233097B1 (fr) Ensemble d'instruments destinés à installer un système de stabilisation dans la colonne vertébrale d'un corps
EP3117787A1 (fr) Vis pediculaire en u
EP2799023A1 (fr) Tournevis pour vis à os
DE3941523A1 (de) Chirurgisches gleitinstrument und verfahren zur handhabung desselben
EP3023065B1 (fr) Système de vis pédiculaire et système de stabilisation de colonne vertébrale
EP0452451A1 (fr) Vis pour pedicule vertebral et dispositif de correction et de maintien pourvu d'une telle vis.
CH666176A5 (de) Einrichtung zur behandlung eines knochens und nagel fuer eine solche einrichtung.
DE102016108504A1 (de) Medizintechnisches Instrument zur provisorischen Fixierung einer polyaxialen Pedikelschraube
EP0496950A1 (fr) Dispositif de visée pour un implant de traitement de fractures trochanterienne et substrochanterienne
DE29710979U1 (de) Implantat zur Fixierung von Knochenteilen und Werkzeug für dieses Implantat
DE9490219U1 (de) Gesperre-Kompressionsvorrichtung
DE202006018587U1 (de) Chirurgisches Instrument zur Implantierung eines Drahtes, vorzugsweise in einen Knochen
EP1311198A1 (fr) Dispositif pour relier un element de fixation osseuse a une tige oblongue
WO2004052218A1 (fr) Dispositif pour stabiliser des os
CH686610A5 (de) Kompressionsimplantat.
EP2505154A1 (fr) Implant de colonne vertébrale
EP1367965A1 (fr) Instrument de positionnement destine a l'insertion d'une coquille d'ecartement
WO2014147104A1 (fr) Système de stabilisation de la colonne vertébrale et élément de fixation chirurgicale pour un système de stabilisation de la colonne vertébrale
EP3031416B1 (fr) Dispositif d'osteosynthese
EP1211991B1 (fr) Dispositif de reduction pour fragments osseux
EP0452792A1 (fr) Fixateur pour la chirurgie des os

Legal Events

Date Code Title Description
PUAI Public reference made under article 153(3) epc to a published international application that has entered the european phase

Free format text: ORIGINAL CODE: 0009012

17P Request for examination filed

Effective date: 20040405

AK Designated contracting states

Kind code of ref document: A1

Designated state(s): AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IT LI LU MC NL PT RO SE SI SK TR

AX Request for extension of the european patent

Extension state: AL LT LV MK

AKX Designation fees paid

Designated state(s): AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IT LI LU MC NL PT RO SE SI SK TR

GRAP Despatch of communication of intention to grant a patent

Free format text: ORIGINAL CODE: EPIDOSNIGR1

RAP1 Party data changed (applicant data changed or rights of an application transferred)

Owner name: ZIMMER GMBH

GRAS Grant fee paid

Free format text: ORIGINAL CODE: EPIDOSNIGR3

GRAA (expected) grant

Free format text: ORIGINAL CODE: 0009210

AK Designated contracting states

Kind code of ref document: B1

Designated state(s): AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IT LI LU MC NL PT RO SE SI SK TR

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: SI

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060405

Ref country code: IE

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060405

Ref country code: RO

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060405

REG Reference to a national code

Ref country code: GB

Ref legal event code: FG4D

Free format text: NOT ENGLISH

REG Reference to a national code

Ref country code: CH

Ref legal event code: EP

Ref country code: CH

Ref legal event code: NV

Representative=s name: DR. GRAF & PARTNER INTELLECTUAL PROPERTY

REG Reference to a national code

Ref country code: SE

Ref legal event code: TRGR

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: MC

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20060430

REG Reference to a national code

Ref country code: IE

Ref legal event code: FG4D

Free format text: LANGUAGE OF EP DOCUMENT: GERMAN

REF Corresponds to:

Ref document number: 50302889

Country of ref document: DE

Date of ref document: 20060518

Kind code of ref document: P

GBT Gb: translation of ep patent filed (gb section 77(6)(a)/1977)

Effective date: 20060602

REG Reference to a national code

Ref country code: DK

Ref legal event code: T3

REG Reference to a national code

Ref country code: ES

Ref legal event code: FG2A

Ref document number: 2258678

Country of ref document: ES

Kind code of ref document: T3

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: PT

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060905

REG Reference to a national code

Ref country code: GR

Ref legal event code: EP

Ref document number: 20060402333

Country of ref document: GR

ET Fr: translation filed
REG Reference to a national code

Ref country code: IE

Ref legal event code: FD4D

PLBE No opposition filed within time limit

Free format text: ORIGINAL CODE: 0009261

STAA Information on the status of an ep patent application or granted ep patent

Free format text: STATUS: NO OPPOSITION FILED WITHIN TIME LIMIT

26N No opposition filed

Effective date: 20070108

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: DK

Payment date: 20070412

Year of fee payment: 5

Ref country code: SE

Payment date: 20070412

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: AT

Payment date: 20070413

Year of fee payment: 5

Ref country code: FI

Payment date: 20070413

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: SK

Payment date: 20070416

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: CZ

Payment date: 20070418

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: BE

Payment date: 20070502

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: TR

Payment date: 20070507

Year of fee payment: 5

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: GR

Payment date: 20070420

Year of fee payment: 5

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: EE

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060405

Ref country code: BG

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060705

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: LU

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20060424

Ref country code: HU

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20061006

BERE Be: lapsed

Owner name: *ZIMMER G.M.B.H.

Effective date: 20080430

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: CY

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20060405

REG Reference to a national code

Ref country code: DK

Ref legal event code: EBP

EUG Se: european patent has lapsed
PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: AT

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080424

Ref country code: SK

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080424

Ref country code: FI

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080424

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: BE

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080430

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: DK

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080430

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: CZ

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080424

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: GR

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20081104

NLV4 Nl: lapsed or anulled due to non-payment of the annual fee

Effective date: 20091101

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: NL

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20091101

REG Reference to a national code

Ref country code: CH

Ref legal event code: PFA

Owner name: ZIMMER GMBH

Free format text: ZIMMER GMBH#SULZER ALLEE 8#8404 WINTERTHUR (CH) -TRANSFER TO- ZIMMER GMBH#SULZER ALLEE 8#8404 WINTERTHUR (CH)

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: SE

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080425

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: TR

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20100914

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: ES

Payment date: 20120419

Year of fee payment: 10

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: TR

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20080424

REG Reference to a national code

Ref country code: ES

Ref legal event code: FD2A

Effective date: 20140708

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: ES

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20130425

REG Reference to a national code

Ref country code: FR

Ref legal event code: PLFP

Year of fee payment: 14

REG Reference to a national code

Ref country code: FR

Ref legal event code: PLFP

Year of fee payment: 15

REG Reference to a national code

Ref country code: FR

Ref legal event code: PLFP

Year of fee payment: 16

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: NL

Payment date: 20190115

Year of fee payment: 13

Ref country code: IT

Payment date: 20190320

Year of fee payment: 17

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: GB

Payment date: 20200316

Year of fee payment: 18

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: FR

Payment date: 20200317

Year of fee payment: 18

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: DE

Payment date: 20200312

Year of fee payment: 18

REG Reference to a national code

Ref country code: CH

Ref legal event code: PL

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: LI

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20200430

Ref country code: CH

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20200430

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: IT

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20200424

REG Reference to a national code

Ref country code: DE

Ref legal event code: R119

Ref document number: 50302889

Country of ref document: DE

GBPC Gb: european patent ceased through non-payment of renewal fee

Effective date: 20210424

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: FR

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20210430

Ref country code: GB

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20210424

Ref country code: DE

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20211103